The nurse is developing a plan of care to prevent separation behaviors in children who are hospitalized for long periods of time. Which of the following items should the nurse include in the plan of care? Select all that apply

When caring for children with life-threatening or terminal illnesses, nurses often face difficult questions about death. School-age children, around 12 years old, understand that death is final and irreversible, and they seek honest, empathetic answers.

Rationale for correct answer:

C. “Some children who have been diagnosed with your illness do die.” This response is honest, developmentally appropriate, and empathetic. At age 12, children in the concrete–formal operational stage (Piaget) understand that death is permanent and universal. They deserve truthful answers. The nurse’s role is to provide open, supportive communication, allowing the child to express fears, feelings, and questions while fostering trust.

Rationale for incorrect answers:

A. “Don’t talk like that. You are going to get better very soon.” This is false reassurance and invalidates the child’s feelings and undermines trust.

B. “It would be best if you were to ask your doctor about that.” This avoids the child’s question, shuts down communication, and conveys that the nurse is uncomfortable discussing important concerns.

D. “It’s hard for me to talk about death. It would be best if you were to ask your parents.” This focuses on the nurse’s feelings instead of the child’s. This avoidance leaves the child unsupported and isolated with their fears.

Take home points

• Children around 10–12 years old understand the permanence of death and may ask direct questions.
• The nurse should respond with honesty, empathy, and openness, validating the child’s feelings while providing comfort.
• Avoid false reassurance or deflection, these erode trust and increase anxiety.
• Facilitating discussions with parents, providers, and chaplains may also help, but the nurse should not avoid the child’s direct questions.

When preparing children for invasive procedures such as a lumbar puncture, it is essential for the nurse to use developmentally appropriate communication and strategies. The nurse’s priority is to ensure safety, cooperation, and emotional support while avoiding threats, shaming, or placing the burden solely on parents.

Rationale for correct answer:

C. A lumbar puncture requires absolute immobility to avoid injury and obtain an accurate sample. A 7-year-old may understand instructions but can still become fearful and unable to stay still on their own. The safest approach is for the nurse to request help so the child can be gently but firmly held in the correct position, ensuring safety and comfort.

Rationale for incorrect answers:

A. While immobility is critical, threatening the child with possible injury increases fear and does not provide supportive guidance.

B. Parents can offer comfort, but the nurse cannot rely solely on them to manage positioning during such a critical and invasive procedure.

D. Telling the child that children who are in elementary school are big enough to be still during procedures dismisses the child’s fear and is developmentally inappropriate. Guilt or shame is not an effective strategy for cooperation.

Take home points

• During invasive procedures like a lumbar puncture, safety and immobility are top priorities.
• The nurse should provide age-appropriate explanations, use comforting techniques, and ensure adequate assistance for positioning.
• Avoid threatening, shaming, or relying only on parents to maintain control — professional staff support is essential.
• A calm, supportive approach helps reduce fear while keeping the procedure safe.